Cardio-renal protection in older people with diabetes with frailty and medical comorbidities - A focus on the new hypoglycaemic therapy

The prevalence of diabetes is increasing particularly in the older age group due to the increased life expectancy. Ageing is associated with vascular and renal changes that predispose older people with diabetes to an increased risk of cardio-renal complications. This manuscript is set to review the use of the sodium glucose transporter-2 (SGLT-2) inhibitors and the glucagon like peptide-1 receptor agonists (GLP1-RA) in older population with diabetes especially in those with comorbidities and frailty. The recently introduced (SGLT-2) inhibitors and the GLP1-RA have shown promising cardio-renal protective outcomes. In addition to the favourable effect of glycaemic control on cardio-renal complications, these new agents seem to add additional benefits independent of their hypoglycaemic properties. The favourable outcomes have been shown in the older age group (>65 years) who were reasonably represented in the randomised controlled clinical trials. However, the evidence for those ≥75 years old is limited due to the small number of the included participants and the few clinical events. Data from both real world and post-hoc analyses of clinical trials is assuring about the use of these new agents in older people. However, it remains reasonable to express caution in using these agents in frail older people with diabetes due to high risk of adverse events in this group. •Ageing is associated with vascular and renal changes that predispose older people with diabetes to adverse events.•The new hypoglycaemic therapy has a favourable effect in those >65 years old that may also include those >75years.•In early to moderate frailty and/or raised comorbidity profile, the new therapy still can be considered.•The new therapy is better avoided in severely frail comorbid older people with diabetes due to high risk of side effects.